Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The claim of Eckstein, that paraffins of low melting points are more
likely to be absorbed, has not been substantiated in actual practice,
since we now know that any and all of these injections, irrespective of
their melting points, are absorbed in time, giving place to connective
tissue, and that rarely, if ever, is there a true and complete
encapsulation or encystment of the mass thus introduced. Even the hard
paraffins are split up in time into minute pearllike particles which
are displaced by the growth of tissue arising from the presence of the
foreign substance. This is true even in those cases in which the author
has introduced by surgical means solid paraffin plates in the cold state.
=6. Sloughing Due to Pressure.=—When an injection is forced into a dense
or firmly bound-down tissue, as into the body of a thickened cicatrix, or
about the point of the nose or the subseptum of the nose without first
dissecting off the skin above the subcutaneous layers, an acute anemia is
at once marked, followed by inflammation and gangrene.
By injecting sterile water into the area thus loosened with the knife a
good idea of the thoroughness of the dissection and the possibility of
building up the part to be corrected is obtained, yet in these cases the
author has always found more or less difficulty in keeping the injected
mass in place for the reason that the divided surfaces tend to unite
at their peripheral borders, crowding the mass upward or to one side
or diffusing it in such a way that the result has been anything but
satisfactory.
To overcome this it is advisable to inject a smaller quantity than
necessary to entirely correct the defect, to mold it out flat and to
allow it to organize before more is introduced.
=7. Subinjection.=—Insufficient injection leading to an undercorrection
of the defect is a far more desirable condition than hyperinjection,
and is easily corrected by a repetition of the treatment, even to a
third sitting, until the desired result is obtained. Following this rule
will give far better results, as has been said, than to be compelled to
remove a part of the filling and some of the connective tissue which has
resulted therefrom.
=8. Hyperinjection.=—The injection of too much vaselin or paraffin is one
of the most common faults found with operators. In the first instance a
tumefaction of the site results which with the production of the tissue
which takes the place of part of the filling makes the result very
unsatisfactory and requires one or more cutting operations to reduce it.
A peculiar fact with these hyperplastic growths is that even though they
may be reduced with the knife to a normal size they seem to redevelop
again and again, giving both surgeon and patient great concern.
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